Healthcare Provider Details

I. General information

NPI: 1093792202
Provider Name (Legal Business Name): FARMACIA SAN PABLO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 CALLE BARCELO
CIDRA PR
00739-3438
US

IV. Provider business mailing address

64 CALLE BARCELO
CIDRA PR
00739-3438
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8300
  • Fax: 787-739-6300
Mailing address:
  • Phone: 787-739-8300
  • Fax: 787-739-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-0559
License Number StatePR

VIII. Authorized Official

Name: MRS. LOURDES BERRIOS
Title or Position: OWNER
Credential: RPH.
Phone: 787-739-8300